Mirizzi综合征的微创外科治疗

目的 总结应用腹腔镜和内镜联合治疗Mirizzi综合征的初步经验，探讨微创外科对Mirizzi综合征的治疗效果。方法 对21例CsendesⅡ型，Ⅲ型Mirizzi综合征患者，采用内镜鼻胆管引流术（ENBD）配合实施腹腔镜胆囊切除，胆总管探查，胆囊胆管瘘I期缝合修补术（内衬ENBD导管）。结果 19例手术成功，2例中转开腹。术中结石清除率100％，无胆漏，胆道出血等术后并发症。手术时间平均93.6min，术后平均住院9．4d。术后随访18－41个月，未有结石复发。结论 应用腹腔镜和内镜手段，综合治疗Mirizzi综合征在技术上是切实可行的。但腹腔镜下缝合修复胆管壁缺损较困难，适宜在腹腔镜技术较成熟的单位开展。

Minimally invasive surgical treatment of Mirizzi syndrome

Objective To study the method of combined laparoscopy and endoscopy ( duodenosco-py and choledochoscopy) in the treatment of Csendes's II, III Mirizzi Syndrome. Methods Twenty one patients with Mirizzi Syndrome were admitted for the procedures. These patients received endoscopic nasobiliary drainage first, followed by laparoscopic subtotal cholecystectomy plus common bile duct(CBD) exploration. Results Satisfactory out come was realized except conversion to open surgery occurred in 2 for failure in repairing due to the extensive adhesions of Calot's triangle and anatomical abnormalities of cystic duct. In the course of operation ,removal of incarcerated stones in neck of gallbladder was performed in 14 cases, extraction of CBD stones by intraoperative choledochoscopy in 5 cases, and all cases received primary suture on the defect of CBD. There was neither residual stones left nor serious after - effect including biliary fistula and he-mobilia. Mean postoperative stay was 9.4 days. Follow - up observations on 19 patients did not show recurrence of stones, nor bile duct stricture during 18-41 months. Conclusion The combined procedures is feasible and safe alternative but can be technically demanding. This management is able to substitute some conventional procedure of T - tube insertion, however, primary suture on the defect bile duct is especially difficult.